Abstract Background Local anesthetic puncture is often related to the experience of pain. This study aimed to systematically analyze the literature on changes in pain perception during the anesthetic puncture of dental local anesthesia after Photobiomodulation Therapy (PBMT). Material and methods An electronic search was performed in eight primary databases (Embase, LILACS, BBO, LIVIVO, MedLine via PubMed, SciELO, Scopus, and Web of Science) and three additional ones (EASY, Google Scholar, and OATD) to partially capture the “gray literature”. The PICO strategy was used to identify randomized clinical trials evaluating the analgesic effect of PBMT in the anesthetic puncture site of dental local anesthesia compared to placebo or control groups, without restrictions on publication language and year. Two reviewers extracted the data and assessed the individual risk of bias of the eligible studies using the Cochrane Collaboration Risk of Bias Tool version 2.0. Results The electronic search found 3,485 records, of which eight met the eligibility criteria and were included in the qualitative synthesis. The studies were published from 2011 to 2022. None of the included studies had a low risk of bias. PBMT groups showed no significant difference in pain scores compared to placebo and control groups of most studies. Conclusion Based on a low to very low certainty of evidence, PBMT seems to have no effect on pain perception during anesthetic puncture in patients undergoing dental local anesthesia. PBMT. . (PBMT) Embase, Embase (Embase LILACS BBO LIVIVO PubMed SciELO Scopus Science EASY, EASY (EASY Scholar OATD gray literature. literature” year 20 2 0 2.0 3485 3 485 3,48 records synthesis 201 2022 evidence (PBMT 2. 348 48 3,4 202 34 4 3,

Abstract Background Lung lymphatic drainage occurs mainly through a peribronchial path, but it is hypothesized that visceral pleural invasion could alter this path. This study aims to investigate the association between visceral pleural invasion, node upstaging, and N2 skip metastasis and the impact on survival in a population of patients with non-small cell lung cancer of 3 cm or smaller. Methods We retrospectively queried our institutional database of lung cancer resection for all patients with clinical stage IA NSCLC between June 2009 and June 2022. We collected baseline characteristics and clinical and pathological staging data. Patients were classified into two groups: The non-VPI group with negative visceral pleural invasion and the VPI group with positive. The primary results analyzed were the occurrence of nodal upstaging, skip N2 metastasis and recurrence. Results There were 320 patients analyzed. 61.3 % were women; the median age was 65.4 years. The pleural invasion occurred in 44 patients (13.7 %). VPI group had larger nodules (2.3 vs. 1.7 cm; p < 0.0001), higher 18F-FDG uptake (7.4 vs. 3.4; p < 0.0001), and lymph-vascular invasion (35.7 % vs. 13.5 %, p = 0.001). Also, the VPI group had more nodal disease (25.6 % vs. 8.7 %; p = 0.001) and skip N2 metastasis (9.3 % vs. 1.8 %; p = 0.006). VPI was a statistically independent factor for skip N2 metastasis. Recurrence occurred in 17.2 % of the population. 5-year disease-free and overall survival were worse in the VPI group. Conclusions The visceral pleural invasion was an independent factor associated with N2 skip metastasis and had worse disease-free and overall survival. path upstaging N nonsmall non small smaller 200 2022 data groups nonVPI positive recurrence 32 613 61 61. women 654 65 4 65. years 13.7 137 13 7 (13. %. . %) 2.3 23 2 (2. vs 17 1 1. 0.0001, 00001 0.0001 , 0 0001 0.0001) 18FFDG FFDG 18F FDG F 7.4 74 (7. 3.4 34 lymphvascular lymph vascular 35.7 357 35 (35. 135 5 13. 0.001. 0.001 001 Also 25.6 256 25 6 (25. 87 8 8. 9.3 93 9 (9. 18 0.006. 0006 0.006 006 0.006) 172 17. 5year year diseasefree free 20 202 (13 2. (2 0000 0.000 000 7. (7 3. 35. (35 0.00 00 25. (25 9. (9 (1 ( (3 0.0 0.

Abstract Aims Very Low Birthweight (VLBW) infants with neonatal Chronic Lung Disease (CLD) have been found to have functional impairment of the brainstem auditory pathway at term. This study investigated the functional status of the brainstem auditory pathway in VLBW infants with CLD after term for any abnormality. Methods Fifty-two VLBW infants were recruited at 50 weeks of Postconceptional Age: 25 with neonatal CLD and 27 without CLD. None had any other major complications to minimize confounding effects. Brainstem Auditory Evoked Responses were studied at 21‒91/s click rates. Results Compared with those without CLD, VLBW infants with CLD had relatively shorter latencies of BAER waves I and III, associated with a slightly lower BAER threshold. Wave V latency and I‒V interpeak interval did not differ significantly between the two groups of infants. The I‒III interval in infants with CLD was shorter than in those without CLD at 91/s clicks. However, the III‒V interval was significantly longer than in those without CLD at all click rates (all p < 0.05). There were no significant differences in the amplitudes of BAER wave components between the two groups of infants. Conclusions The main BAER abnormality in VLBW infants with CLD was a prolonged III‒V interval. Auditory conduction is delayed or impaired at more central regions of the brainstem in CLD infants. After term central auditory function is adversely affected by neonatal CLD. Monitoring post-term change is required to provide valuable information for post-term care of CLD infants. (VLBW (CLD Fiftytwo Fifty 5 Age 2 effects 2191s s 21 91 III threshold IV IIII 91s clicks However IIIV 0.05. 005 0.05 . 0 05 0.05) postterm post 9 00 0.0 0.

Abstract Introduction and hypothesis Internal vaginal pessary is among the leading treatments for pelvic organ prolapse (POP); however, it has a high adverse event rate. An external pessary was recently developed as an alternative. The study's objective was to compare the efficacy of external and internal pessaries in treating POP in postmenopausal women. Methods This parallel randomized (1:1 ratio) open-blind study included 40 symptomatic women with stage 2 or 3 POP. They were randomized into two groups: group 1 (internal pessary) and group 2 (external pessary) (n = 20 in each); and evaluated at the start of and 3 months after the treatment. Statistical analysis was performed to compare the results within and between the groups before and after the 3-month treatment. Results The groups were homogeneous, except for the variables previous pregnancies (p = 0.030) and POP-Q score of apical prolapse (p = 0.023) whose values were higher in group 2. A significant improvement in quality of life was observed in both groups after 3 months of follow-up; however, internal pessaries were found to be more effective (p < 0.001). In group 1 there were differences between the initial and final POP-Q scores of anterior (0.004) and apical prolapse (p = 0.005). The complication rate associated with internal pessary use was high (p = 0.044). Conclusions The present data suggested that external pessaries have a similar effect to internal ones for the treatment of POP and improvement of the quality of life of postmenopausal women. (POP) however alternative studys s 11 (1: ratio openblind open blind 4 n each each) 3month month homogeneous p 0.030 0030 0 030 POPQ Q 0.023 0023 023 followup follow up follow-up 0.001. 0001 0.001 . 001 0.001) 0.004 0004 004 (0.004 0.005. 0005 0.005 005 0.005) 0.044. 0044 0.044 044 0.044) (POP (1 0.03 003 03 0.02 002 02 000 0.00 00 (0.00 0.04 04 ( 0.0 (0.0 0. (0. (0

Abstract Objectives To investigate the impact of Three-Dimensional (3D) laparoscopy compared to traditional laparotomy on serum tumor markers and coagulation function in patients diagnosed with early-stage Endometrial Cancer (EC). Method The authors retrospectively analyzed the clinical data of 75 patients diagnosed with early-stage EC and categorized them into two groups based on the surgical techniques employed. The 3D group consisted of 36 patients who underwent 3D laparoscopic surgery, while the Laparotomy group comprised 39 patients who underwent traditional laparotomy. The authors then compared the alterations in serum tumor markers and coagulation function between the two groups. Results Postoperatively, serum levels of CA125, CA199, and HE4 were notably reduced in both groups on the third day, with the levels being more diminished in the 3D group than in the Laparotomy Group (p < 0.05). Conversely, FIB levels escalated significantly in both groups on the third-day post-surgery, with a more pronounced increase in the 3D group. Additionally, PT and APTT durations were reduced and were more so in the 3D group than in the laparotomy group (p < 0.05). Conclusions When juxtaposed with traditional laparotomy, 3D laparoscopic surgery for early-stage EC appears to be more efficacious, characterized by reduced complications, and expedited recovery. It can effectively mitigate serum tumor marker levels, attenuate the inflammatory response and damage to immune function, foster urinary function recovery, and enhance the quality of life. However, it exerts a more significant influence on the patient's coagulation parameters, necessitating meticulous prevention and treatment strategies for thromboembolic events in clinical settings. ThreeDimensional Three Dimensional D (3D earlystage early stage EC. . (EC) 7 employed 3 Postoperatively CA125 CA CA199 HE day p 0.05. 005 0.05 0 05 0.05) Conversely thirdday postsurgery, postsurgery post post-surgery Additionally efficacious complications recovery life However patient s parameters settings (EC CA12 CA19 00 0.0 CA1 0.

Abstract Objective To adapt the Scale of Perception of Respect for and Maintenance of the Dignity of the Inpatient (CuPDPH) to the Brazilian language and culture and to assess its psychometric properties. Results The scale was evaluated by 15 experts, and 239 patients from three tertiary hospitals in Rio de Janeiro. All participants signed a consent form. Data have shown adequacy of the model (KMO=0.839, Bartlett's test of sphericity: χ2(171) = 2241.3, p = 0.000010), good adjusted content validity (CVCa ≥ 0.90), internal consistency and reliability, such as α = 0.927. Discussion CuPDPH is a rating scale on observable professional attitudes. Illnesses change lives and impose adaptation to a new situation, perceived as depersonalization, leading patients to try to regain control of their lives. Patients expressed “ill will” to fill out the scale. Psychiatric patients’ scale filling time was higher than others. A sample from three Rio de Janeiro third-level hospitals may not reflect the country's population; also, this adaptation may not comprise all linguistic variations of Brazilian Portuguese and Portuguese-speaking countries. Conclusion The Portuguese version of the Scale of Perception of Respect for and Maintenance of the Dignity of the Inpatient (CuPDPH), a 19-item, six-component version is a reliable instrument to measure the perception of internal medicine, surgical, and psychiatric patients on the maintenance of their dignity in Rio de Janeiro, Brazil. This knowledge could be used in advancing research on patients’ perception of dignity, as well as professional ethical competencies, staff-patient relationship skills, and leadership development in medical and other healthcare professional education. (CuPDPH properties 1 experts 23 form KMO=0.839, KMO0839 KMO 0 839 (KMO=0.839 Bartletts Bartlett s sphericity χ2171 χ χ2 171 χ2(171 22413 2241 3 2241.3 0.000010, 0000010 0.000010 , 000010 0.000010) CVCa 0.90, 090 0.90 90 0.90) reliability 0927 927 0.927 attitudes situation depersonalization ill will others thirdlevel third level countrys country population also Portuguesespeaking speaking countries CuPDPH, 19item, 19item item 19 item, 19-item sixcomponent six component medicine surgical Brazil competencies staffpatient staff patient skills education 2 KMO=0.839 KMO083 83 (KMO=0.83 χ217 17 χ2(17 224 2241. 000001 0.00001 00001 09 0.9 9 092 92 0.92 KMO=0.83 KMO08 8 (KMO=0.8 χ21 χ2(1 22 00000 0.0000 0000 0. KMO=0.8 KMO0 (KMO=0. χ2( 0.000 000 KMO=0. (KMO=0 0.00 00 KMO=0 (KMO= 0.0 KMO= (KMO

Abstract Neurocutaneous syndromes comprise a heterogeneous group of congenital or hereditary conditions that are known to be associated with the risk of different disorders and complications. Two of the most common neurocutaneous syndromes are Neurofibromatosis type 1 (NF1) and Tuberous Sclerosis Complex (TSC). Although there appears to be a general consensus on the importance of a multidisciplinary approach in managing these cases, there is still very little emphasis in discussions addressed in the literature on the role of dentistry in accordance with the perspective of comprehensive care. Evidence-based propositions, together with a broad discussion of new insights in this regard, should have the ability to strongly impact related future perspectives, aiming for greater advances and better outcomes for these patients. In this review article, the authors discuss updated general aspects of NF1 and TSC, and the potential additional roles of dentistry, in addition to addressing suggestions for actions in dentistry at related levels of care, as well as priorities for future research. complications NF (NF1 TSC. TSC . (TSC) cases care Evidencebased Evidence based propositions regard perspectives patients article research (NF (TSC

Abstract Objectives The COVID-19 pandemic has had a significant global impact since its declaration in March 2020. The COVID-19 pandemic has disproportionately impacted cancer patients, particularly those with breast cancer. This study aims to analyze the effects of the pandemic on women diagnosed with breast cancer recurrence. Methods A cohort study was conducted at a tertiary public hospital in São Paulo State, Brazil. Data were collected from electronic records. Patients diagnosed with breast cancer and experiencing recurrence between January 2011 and March 2022 were included. Survival analysis was performed using the Kaplan-Meier estimator and Cox regression. Results The study included 187 patients, 45 in the pandemic group (recurrence after March 23, 2020) and 142 in the pre-pandemic group. Distant recurrences were more frequent in both groups (pre-pandemic: 62.7 %, pandemic: 75.5 %). Compared to the pre-pandemic group (1.8 years), the pandemic group experienced a longer mean time to recurrence detection (2.9 years) and significantly decreased median survival (9 months vs. 22 months). The Cox regression analysis confirmed an increased risk of death for women diagnosed with breast cancer recurrence during the pandemic period (HR = 1.92, 95 % CI 1.19‒3.12). Conclusion The present study is among the first to investigate the pandemic's specific effects on breast cancer recurrence, revealing concerning delays in detection and a decrease in survival rates. Prompt diagnosis, timely treatment initiation, and comprehensive support are crucial during public health crises. These findings urge healthcare systems to prioritize tailored care for breast cancer patients during pandemics. COVID19 COVID 19 COVID-1 2020 State Brazil records 201 202 KaplanMeier Kaplan Meier 18 4 23 14 prepandemic pre (pre-pandemic 627 62 7 62. 755 75 5 75. %. . %) 1.8 1 8 (1. years, years , 2.9 29 2 9 (2. ( vs months. months) HR 192 92 1.92 1.19‒3.12. 119312 1.19‒3.12 3 12 1.19‒3.12) pandemics s rates diagnosis initiation crises COVID1 COVID- 20 6 1. (1 2. (2 1.9 11931 1.19‒3.1 1193 1.19‒3. 119 1.19‒3 11 1.19‒ 1.19 1.1

Abstract The authors conducted a prospective observational study to investigate the prognostic value of high-sensitivity Troponin I (hs-TnI) in the short- and long-term periods after orthopedic surgery, including Total Hip and Knee Arthroplasty (THA and TKA, respectively), in a tertiary orthopedic center in Brazil. Perioperative Myocardial Injury (PMI) was defined as an absolute increase in hs-TnI of ≥ 26 ng/L above preoperative values. The primary endpoint was all-cause mortality assessed at 30 days and 18 months after surgery. The secondary endpoint consisted of a composite outcome: cardiovascular death, acute myocardial infarction, angina requiring revascularization, and/or stroke. The authors compared Relative Risks (RR) of all-cause mortality and composite outcomes in patients with or without PMI at 30 days and 18 months. A Cox proportional hazards model for long-term outcomes was calculated and adjusted for age > 70 years, gender, and Revised Cardiac Risk Index (RCRI) class ≥ 2. PMI occurred in 3.4 % of all surgeries. At 30-days, 6.6 % of patients with PMI had died versus none without PMI. At 18 months, 20.0 % of PMI versus 4.7 % without PMI had died (RR = 5.0; 95 % Confidence Interval [95 % CI 1.3-19.3]). Based on composite outcomes in short and long-term periods, the RRs were 16.2 (95 % CI 2.7-96.5) and 7.7 (95 % CI 2.2-26.6), respectively. PMI was associated with all-cause mortality after 18 months and increased risk for a composite outcome (Hazard Ratio [HR = 3.97], 95 % CI 1.13-13.89 and HR = 5.80, 95 % CI 1.93-17.45, respectively). Patients with PMI who underwent THA or TKA presented worse short- and long-term prognoses compared to those without PMI. highsensitivity high sensitivity hsTnI hs TnI (hs-TnI longterm long term surgery respectively, respectively , respectively) Brazil (PMI 2 ngL ng L values allcause cause 3 1 death infarction revascularization andor stroke RR 7 years gender RCRI (RCRI 34 4 3. surgeries 30days, 30days days, 30-days 66 6 6. 200 20 0 20. 47 4. 5.0 50 5 9 [9 1.319.3. 13193 1.3 19.3 . 19 1.3-19.3]) 162 16 16. (9 2.796.5 27965 2.7 96.5 96 2.7-96.5 77 7. 2.226.6, 22266 2.2 26.6 2.2-26.6) Hazard 3.97, 397 3.97 97 3.97] 1.1313.89 1131389 1.13 13.89 13 89 1.13-13.8 580 80 5.80 1.9317.45, 1931745 1.93 17.45, 93 17 45 1.93-17.45 5. [ 319 1.319.3 1319 1. 193 19. 1.3-19.3] ( 796 2.796. 2796 27 965 96. 2.7-96. 226 2.226.6 2226 22 266 26. 2.2-26.6 39 3.9 1313 1.1313.8 113138 113 1.1 1389 13.8 8 1.13-13. 58 5.8 9317 1.9317.45 193174 1.9 1745 17.45 1.93-17.4 31 1.319. 131 1.3-19.3 79 2.796 279 2.7-96 2.226. 222 2.2-26. 1.1313. 11313 11 138 13. 1.13-13 931 1.9317.4 19317 174 17.4 1.93-17. 1.319 1.3-19. 2.79 2.7-9 2.226 2.2-26 1.1313 1131 1.13-1 1.9317. 1931 17. 1.93-17 1.31 1.3-19 2.7- 2.22 2.2-2 1.131 1.13- 1.9317 1.93-1 1.3-1 2.2- 1.931 1.93- 1.3-

Abstract Objective To evaluate the relationship between genetic haplotypes associated with celiac disease (Human Leucocyte Antigen [HLA] DQ2 and DQ8) with the diagnosis, clinical presentation, and location of endometriosis in Brazilian women. Method A retrospective cross-sectional study, was conducted in a Tertiary hospital. Patients Women aged 18-50 years who underwent HLA-DQ2 and HLA-DQ8 haplotype analysis. Intervention The patients were divided into endometriosis and control groups and evaluated for symptoms; endometriosis location, American Society for Reproductive Medicine (ASRM) stage, and the presence of anti-tissue transglutaminase IgA (anti-TgA), HLA-DQ2, and HLA-DQ8 markers. Results A total of 434 consecutive patients with (n = 315) and without (n = 119) endometriosis were included. Pain and infertility were more frequent in the endometriosis group than in the control group. The presence of HLA-DQ2, HLA-DQ8, and anti-TgA was similar between both groups. The presence of HLA-DQ2 and HLA-DQ8 markers did not differ based on age, pain symptoms, ASRM stage, or endometriosis location. Conclusion Although there are similarities in inflammatory markers and pathophysiology between celiac disease and endometriosis, this study found no significant associations in the presence of HLA-DQ2 or HLA-DQ8 haplotypes and endometriosis. Human HLA [HLA DQ DQ8 diagnosis presentation women crosssectional cross sectional hospital 1850 18 50 18-5 HLADQ2 HLADQ HLA-DQ HLADQ8 analysis symptoms (ASRM stage antitissue anti tissue antiTgA, antiTgA TgA , (anti-TgA) HLADQ2, DQ2, 43 n 315 119 included HLADQ8, DQ8, age 185 1 5 18- (anti-TgA 4 31 11 3

Abstract Introduction Autism Spectrum Disorder (ASD) is a heterogeneous neurodevelopmental disorder, with main manifestations related to communication, social interaction, and behavioral patterns. The slight dynamics of change in the child over time require that the onset of clinical manifestations presented by the child be more valued, with the aim of stabilizing the condition. Faced with a variety of methods for diagnosing ASD, the question arises as to which method should be used. This systematic review aims to recommend the best tools to perform screening and diagnosis. Methodology This systematic review followed the PRISMA guidelines. The databases MEDLINE, Embase, CENTRAL (Cochrane), and Lilacs were accessed, and gray and manual searches were performed. The search strategy was created with terms referring to autism and the diagnosis/broad filter. The studies were qualitatively evaluated and quantitatively. Statistical analysis was performed using Meta-diSc-2.0 software, the confidence interval was 95 %. Results The M-CHAT-R/F tool demonstrated a sensitivity of 78 % (95 % CI 0.57‒0.91) and specificity of 0.98 (95 % CI 0.88-1.00). The diagnostic tools demonstrated sensitivity and specificity respectively of: ADOS, sensitivity of 87 % (95 % CI 0.79‒0.92) and specificity 75 % (95 % CI 0.73‒0.78); ADI-R demonstrated test sensitivity of 77 % (95 % CI 0.56‒0.90) and specificity 68 % (95 % CI 0.52‒0.81), CARS test sensitivity was 89 % (95 % CI 0.78‒0.95) and specificity 79 % (95 % CI 0.65‒0.88). Conclusion It is mandatory to apply a screening test, the most recommended being the M-CHAT-R/F. For diagnosis CARS and ADOS are the most recommended tools. ASD (ASD disorder communication interaction patterns valued condition used guidelines MEDLINE Embase Cochrane, Cochrane , (Cochrane) accessed diagnosisbroad broad filter quantitatively MetadiSc2.0 MetadiSc20 MetadiSc Meta diSc 2.0 2 0 Meta-diSc-2. software 9 MCHATR/F MCHATRF M CHAT R/F R F 7 (9 0.57‒0.91 057091 57 91 098 98 0.9 0.881.00. 088100 0.88 1.00 . 88 1 00 0.88-1.00) 8 0.79‒0.92 079092 92 0.73‒0.78 073078 73 0.73‒0.78) ADIR ADI 0.56‒0.90 056090 56 90 6 0.52‒0.81, 052081 0.52‒0.81 52 81 0.52‒0.81) 0.78‒0.95 078095 0.65‒0.88. 065088 0.65‒0.88 65 0.65‒0.88) MCHATR/F. R/F. (Cochrane MetadiSc2 MetadiSc2. 20 2. Meta-diSc-2 MCHATR RF ( 0.57‒0.9 05709 5 09 0. 881 0.881.00 08810 088 0.8 100 1.0 0.88-1.00 0.79‒0.9 07909 0.73‒0.7 07307 0.56‒0.9 05609 05208 0.52‒0.8 0.78‒0.9 07809 06508 0.65‒0.8 Meta-diSc- 0.57‒0. 0570 0.881.0 0881 08 10 1. 0.88-1.0 0.79‒0. 0790 0.73‒0. 0730 0.56‒0. 0560 0520 0.52‒0. 0.78‒0. 0780 0650 0.65‒0. Meta-diSc 0.57‒0 057 0.881. 0.88-1. 0.79‒0 079 0.73‒0 073 0.56‒0 056 052 0.52‒0 0.78‒0 078 065 0.65‒0 0.57‒ 05 0.881 0.88-1 0.79‒ 07 0.73‒ 0.56‒ 0.52‒ 0.78‒ 06 0.65‒ 0.57 0.88- 0.79 0.73 0.56 0.52 0.78 0.65 0.5 0.7 0.6

Abstract Introduction Studies suggest peripheral airway abnormalities in Pulmonary Arterial Hypertension (PAH). Impulse Oscillometry (IOS) is a noninvasive and sensitive technique for assessing the small airways. It evaluates the impedance of the respiratory system ‒ Resistance (R) and reactance (X) ‒ to a pulse of sound waves sent to the lungs, in a range of frequencies (5‒20 Hz). Method Resistance variables: R5, R20, R5-R20 and reactance variables: AX (reactance area) and Fres (resonance frequency). The aim is to evaluate R and X in patients with idiopathic PAH (IPAH) and to investigate whether there is a correlation between IOS and spirometry. Results Thirteen IPAH patients and 11 healthy subjects matched for sex and age underwent IOS and spirometry. IPAH patients had lower FVC and FEV1 values (p < 0.001), VEF1/CVF (p = 0.049) and FEF 25-75 (p = 0.006) than healthy patients. At IOS, IPAH patients showed lower tidal volumes and higher AX (p < 0.05) compared to healthy individuals, and 53.8 of patients had R5-R20 values ≥ 0.07 kPa/L/s. Correlation analysis: X5, AX, R5-R20 and Fres showed moderate correlation with FVC (p = 0.036 r = 0.585, p = 0.001 r = -0.687, p = 0.005 r = -0.726 and p = 0.027 r = -0.610); Fres (p = 0.012 r = -0.669) and AX (p = 0.006 r = -0.711) correlated with FEV1; [R5 and R20, (R5-R20)] also correlated with FEV1 (p < 0.001 r = -0.573, p = 0.020 r = -0.634 and p = 0.010 r = -0.683, respectively) in the IPAH group. There were also moderate correlations of FEF 25-75 % with Z5 (p = 0.041), R5 (p = 0.018), Fres (p = 0.043) and AX (p = 0.023). Discussion Patients showed changes suggestive of increased resistance and reactance in the IOS compared to healthy individuals, and the IOS findings showed a good correlation with spirometry variables. PAH. . (PAH) (IOS airways (R (X lungs 5‒20 520 5 20 (5‒2 Hz. Hz Hz) variables R20 R5R20 RR R5-R2 area resonance frequency. frequency frequency) (IPAH 1 FEV 0.001, 0001 , 0 001 0.001) VEF1CVF VEFCVF VEF1 CVF VEF 0.049 0049 049 2575 25 75 25-7 0006 006 0.05 005 05 individuals 538 53 8 53. 007 07 0.0 kPaLs kPa L s kPa/L/s analysis X5 0036 036 0.03 0585 585 0.585 0.00 0.687, 0687 687 -0.687 0005 0.726 0726 726 -0.72 0027 027 0.02 0.610 0610 610 -0.610) 0012 012 0.01 0.669 0669 669 -0.669 0.711 0711 711 -0.711 [R (R5-R20) 0.573, 0573 573 -0.573 0020 020 0.634 0634 634 -0.63 0010 010 0.683, 0683 683 -0.683 respectively group Z 0.041, 0041 0.041 041 0.041) 0.018, 0018 0.018 018 0.018) 0.043 0043 043 0.023. 0023 0.023 023 0.023) (PAH 5‒2 52 2 (5‒ R2 R5R2 R5-R 000 00 0.04 004 04 257 7 25- 0. 003 03 058 58 0.58 0.687 068 68 -0.68 0.72 072 72 -0.7 002 02 0.61 061 61 -0.610 01 0.66 066 66 -0.66 0.71 071 71 -0.71 (R5-R20 0.573 057 57 -0.57 0.63 063 63 -0.6 0.683 5‒ (5 R5R 0.5 0.68 06 6 0.7 -0. 0.6 -0.61 (R5-R2 0.57 -0.5 ( -0 (R5-R -

Abstract Introduction The maternal mortality rate in developing countries, such as Brazil, has significantly increased since 2020. Obstetric Emergencies (OE) account for 72.5% of these deaths. A national survey was conducted in Brazil to evaluate how gynecologists and obstetricians deal with OE and identify the main difficulties regarding theoretical/practical knowledge and structural resources. Methods An electronic questionnaire assessing resource availability, health teams, institutional protocols, and provision of OE training courses was completed by Brazilian obstetricians. Results More than 90 % of the questionnaire respondents reported treating a pregnant and/or puerperal patient with severe morbidity and that their health network has human resources, trained professionals, and structural resources required for this type of care. However, few respondents participate in continuing education programs (36 %) or specific training for the medical team (61.41 %). The implementation rates of obstetric risk identification protocols (33.09 %), a rapid response team (46.54 %), and boxes and emergency cart assembly teams (71.68 %) were determined. Conclusion A high Maternal Mortality Ratio (MMR) may be related to disorganized healthcare systems, low implementation of risk classification protocols for the care of severe maternal and fetal conditions, and lack of access to continued/specific training programs. The Brazilian MMR is multifactorial. According to obstetricians, Brazilian health services include care teams, essential medications, obstetric centers, and clinical analysis laboratories, though they lack systematized processes and permanent professional training for qualified care of OE. countries 2020 (OE 725 72 5 72.5 deaths theoreticalpractical theoretical practical availability 9 andor professionals However 36 (3 61.41 6141 61 41 (61.4 %. . 33.09 3309 33 09 (33.0 %, , 46.54 4654 46 54 (46.5 71.68 7168 71 68 (71.6 determined (MMR systems conditions continuedspecific continued multifactorial medications centers laboratories 202 7 72. 3 ( 61.4 614 6 4 (61. 33.0 330 0 (33. 46.5 465 (46. 71.6 716 (71. 20 61. (61 33. (33 46. (46 71. (71 2 (6 (4 (7

Abstract Background Xuebijing (XBJ) is widely applied in the treatment of Acute Lung Injury (ALI). This study focused on the potential mechanism of XBJ in Lipopolysaccharide (LPS)-induced ALI. Methods The rat ALI model was established by injection of LPS (10 mg/kg) and pretreated with XBJ (4 mL/kg) three days before LPS injection. BEAS-2B cell line was stimulated with LPS (1 μg/mL) and ATP (5 mM) to induce pyroptosis, and XBJ (2 g/L) was pretreated 24h before induction. The improvement effects of XBJ on pulmonary edema, morphological changes, and apoptosis in ALI lung tissue were evaluated by lung wet/dry weight ratio, HE-staining, and TUNEL staining. Inflammatory cytokines in lung tissue and cell supernatant were determined by ELISA. pyroptosis was detected by flow cytometry. Meanwhile, the expressions of miR-181d-5p, SPP1, p-p65, NLRP3, ASC, caspase-1, p20, and GSDMD-N in tissues and cells were assessed by RT-qPCR and immunoblotting. The relationship between miR-181d-5p and SPP1 in experimental inflammation was reported by dual luciferase assay. Results XBJ could improve inflammation and pyroptosis of ALI by inhibiting contents of inflammatory cytokines, and levels of inflammation- and pyroptosis-related proteins. Mechanistically, XBJ could up-regulate miR-181d-5p and inhibit SPP1 in ALI. miR-181d-5p can target the regulation of SPP1. Depressing miR-181d-5p compensated for the ameliorative effect of XBJ on ALI, and overexpressing SPP1 suppressed the attenuating effect of XBJ on LPS-induced inflammation and pyroptosis. Conclusion XBJ can regulate the miR-181d-5p/SPP1 axis to improve inflammatory response and pyroptosis in ALI. (XBJ . (ALI) LPSinduced induced 10 mg/kg mgkg mg kg 4 ( mL/kg mLkg mL BEAS2B BEASB BEAS 2B B 1 μg/mL μgmL μg 5 mM 2 g/L gL g L h induction edema changes wetdry wet dry ratio HEstaining, HEstaining HE staining, staining HE-staining ELISA cytometry Meanwhile miR181d5p, miR181d5p miRdp miR 181d 5p, 5p d p SPP pp65, pp65 pp p65, p65 p-p65 NLRP3 NLRP ASC caspase1, caspase1 caspase 1, caspase-1 p20 GSDMDN GSDMD N RTqPCR RT qPCR immunoblotting assay pyroptosisrelated related proteins Mechanistically upregulate up miR181d5p/SPP1 miR181d5pSPP1 miRdpSPP 5p/SPP1 miR-181d-5p/SPP (ALI pp6 p6 p-p6 caspase- p2 miR181d5p/SPP pSPP miR181d5pSPP 5pSPP1 5p/SPP p-p 5pSPP